Angiotensin-converting enzyme inhibition alters the fibrinolytic response to cardiopulmonary bypass

Article

关键词: PLASMINOGEN-ACTIVATOR INHIBITOR-1;    UNCOMPLICATED MYOCARDIAL-INFARCTION;    TYPE-1 RECEPTOR ANTAGONISM;    CARDIAC-SURGERY;    VASOCONSTRICTOR REQUIREMENTS;    PLASMA;    INCREASE;    RELEASE;    BRADYKININ;    SYSTEM;   

DOI  :  10.1161/01.CIR.0000105765.54573.60

来源: SCIE

【 摘 要 】

Background - Increased plasminogen activator inhibitor-1 (PAI-1) concentrations after coronary artery bypass grafting (CABG) are associated with increased risk of vein graft occlusion. Because angiotensin II stimulates PAI-1 expression, we tested the hypothesis that preoperative angiotensin-converting enzyme ( ACE) inhibition decreases PAI-1 expression after CABG. Methods and Results - We measured the effects of cardiopulmonary bypass (CPB) on PAI-1 antigen and tissue-type plasminogen activator (tPA) antigen and activity in 31 patients taking an ACE inhibitor (ACEI) who were randomized to continue ACEI until the morning of surgery (ACEI group, n = 19) or to discontinue it 48 hours before surgery (No-ACEI group, n = 12). Arterial blood samples were taken at baseline before CPB, twice during CPB, after separation from CPB, and on postoperative day 1 (POD1). CPB caused an early decrease in PAI-1 antigen, followed by an increase in PAI-1 antigen on POD1 ( P < 0.001 for effect of time). ACE inhibition attenuated the increase in PAI-1 antigen such that both PAI-1 antigen on POD1 ( P = 0.013) and the change in PAI-1 antigen from baseline to POD1 ( P = 0.009) were higher in the No-ACEI group (from 17.0 +/- 5.0 to 48.7 +/- 8.8 ng/mL) versus the ACEI group (from 19.9 +/- 3.4 to 33.1 +/- 6.2 ng/mL). There was no significant difference between the 2 groups in intraoperative tPA activity ( P = 0.259); however, the increase in tPA activity was significantly greater in the ACEI group than in the No-ACEI group ( P = 0.030). Conclusions - Preoperative ACEI attenuates the increase in PAI-1 after CABG, suggesting a role for ACE inhibition in reducing the risk of acute graft thrombosis.

【 授权许可】

Free